Term
| What are the types of COPD? |
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Definition
| Chronic bronchitis and emphysema |
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Term
| Define chronic bronchitis |
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Definition
| Chronic productive cough for 3 mths in each of 2 consecutive yrs in a pt that other ddx of chronic cough have been r/o |
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Term
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Definition
| Abnormal and permanent enlargement of the airspaces that are distal to the terminal bronchioles |
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Term
| What is mortality of COPD? |
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Definition
| 4th leading cause of death in US - rate has doubles q 5 years in the past 20 yrs |
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Term
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Definition
| Chronic tobacco exposure, air pollution, frequent bronchial infections, alpha-1 antitrypsin deficiency |
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Term
| Risk factors for COPD? (7) |
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Definition
| Tobacco smoke exposure, occupational dust and chemicals, poor nutrition, low SES, h/o childhood respiratory infections, genetics, increasing age |
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Term
| What happens to airways in the early stages of chronic bronchitis? |
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Definition
| mucus plugging, inflammation, peribronchial fibrosis, narrowing and obliteration |
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Term
| What occurs in established chronic bronchitis? |
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Definition
| mucus gland hyperplasia, mucosal inflammation and edema, bronchospasm, and impacted secretions - contribute to airway narrowing and increased resistance |
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Term
| What occurs to lung tissue in emphysema? |
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Definition
| destruction of alveolar walls and tissue support (produces dilated airways), unsupported airways collapse during expiration d/t low lung volumes |
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Term
| Which type of COPD pt is described as a "blue bloater"? Why? |
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Definition
| COPD - have cyanosis and peripheral edema |
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Term
| What is the major c/o of a pt presenting /c chronic bronchitis? |
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Definition
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Term
| What is the typical age and physical appearance of a chronic bronchitis pt? |
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Definition
| Late 30s and 40s, overweight, dyspnea upon exertion but comfortable at rest |
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Term
| Are adventitious breath sounds heard in a pt w/ chronic bronchitis? |
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Definition
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Term
| What nickname is used to desctibe the appearance of pts w/ emphysema? |
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Definition
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Term
| What is the major c/o of a pt w/ emphysema? |
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Definition
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Term
| Describe the age and physical appearance of a pt w/ emphysema. |
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Definition
| Present > 50 yo, thin w/ evidence of wt loss, appear uncomfortable w/ active accesory mus. use |
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Term
| Are adventitious breath sound heard in a pt w/ emphysema? |
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Definition
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Term
| Which type of COPD pt has a barrel chest? |
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Definition
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Term
| What can be expected on a PE of a COPD pt? |
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Definition
| decreased tactile fremitus, hyperresonance, decreased breath sounds, prolonged expiration, crackles, rhonchi, and wheezes (chronic bronchitis), and depressed diaphragm |
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Term
| Name 5 key indicators for dx of COPD |
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Definition
| 1) Chronic cough 2) chronic sputum production 3) dyspnea 4) repeated episodes of acute bronchitis 5) Exposure to risk factors (ETS, air pollution) |
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Term
| Describe sputum production in a COPD pt |
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Definition
| initially mucoid but becomes purulent w/ exacerbation, worse in the winter |
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Term
| Desctibe dyspnea present in a COPD pt |
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Definition
| progressive, persistent, worse on exercise, worse during respiratory infxns |
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Term
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Definition
| bronchial asthma, alpha-1 antitrypsin deficiency, CF, central airflow obstruction |
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Term
| How do COPD and asthma differ in onset and progression of sx? |
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Definition
| COPD onset is in midlife w/ a slow progression of sx, asthma onset is in early life and has varying sx that are worse at night or early morning |
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Term
| Is airflow limitation in COPD reversible? In Asthma? |
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Definition
| COPD - irreversible and asthma - reversible |
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Term
| What 3 other conditions are often present in pts w/ asthma but not COPD? |
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Definition
| allergy, rhinitis, and/or eczema |
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Term
| What labs can be altered in pts w/ chronic bronchitis? |
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Definition
| Elevated Hb, reduced PaO2, and increased PaCO2 |
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Term
| Describe CXR of a chronic bronchitis pt |
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Definition
| increased interstitial markings(dirty lungs) at base, tubing (mucus plugs in airways), diaphragm is not flattened |
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Term
| Describe PFT of a pt w/ chronic bronchitis |
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Definition
| expiratory flow obstruction, TLC normal (slight increase), normal diffusing capacity |
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Term
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Definition
| normal Hb, normal to slight decreased PaO2, normal to slight increased PaCO2 |
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Term
| PFTs in a pt w/ emphysema? |
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Definition
| Expiratory flow obstruction, TLC increased, diffuse capacity decreased |
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Term
| How is spirometry used for pt w/ COPD? (4 broad) |
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Definition
| diagnosis, assessing severity, assessing prognosis, monitoring progression |
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Term
| What spirometry results would indicate a pt has stage I or mild COPD? |
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Definition
| FEV1/FVC < 0.7, FEV1 > or = 80% predicted |
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Term
| Stage II or moderate COPD? |
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Definition
| FEV1/FVC < 0.7,< or = 50% FEV1 < 80% predicted |
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Term
| Stage III or severe COPD? |
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Definition
| FEV1/FVC < 0.7, < or = 30% FEV1 < 50% predicted |
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Term
| Stage IV or very severe COPD? |
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Definition
| FEV1/FVC < 0.7, FEV1 < 30% or FEV1 < 50% plus chronic respiratory failure |
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Term
| Can COPD be cured? What is treatment based off of? |
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Definition
| No it can be only managed, based on severity of sx |
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Term
| What meds are central to the tx of COPD? |
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Definition
| bronchodilators - beta 2 agonists, anticholinergics, and methylxanthines |
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Term
| Give ex. of beta 2 agonist inhalers? Which are more effective for COPD tx? |
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Definition
| Short acting: albuterol, levalbuterol and long acting: salmetrol, formoterol. Long acting preferred |
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Term
| Ex. of anticholinergic bronchodilators? |
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Definition
| short acting: ipratropium and long acting: tiotropium |
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Term
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Definition
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Term
| When is it recommended to add glucocorticoids to bronchodilators for COPD tx? Give an ex. |
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Definition
| Stage III or IV COPD, repeated exacerbations. Fluticasone |
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Term
| Do antioxidant agents such as N-acetylcysteine help to reduce frequency of COPD exacerbations? |
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Definition
| No - except in pts tx w/ inhaled glucocorticoids |
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Term
| Are mucolytic agents, antitussives, or bronchodilators rec. to tx COPD? |
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Definition
| Not in stabel COPD - can induce bronchoconstriction |
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Term
| Are mucolytic agents, antitussives, or bronchodilators rec. to tx COPD? |
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Definition
| Not in stabel COPD - can induce bronchoconstriction |
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Term
| What non-pharmacologic therapies are used to tx COPD? |
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Definition
| exercise training programs and long-term oxygen therapy |
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Term
| What surgical interventions can be done to tx COPD? |
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Definition
| long volume reduction surgery to relieve dyspnea and improve exercise tolerance, and lung transplantation to improve funtional capacity (75% 2 yr survival) |
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Term
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Definition
| acute increase in sx beyond normal variances - usu. cough, sputum production, and/or dyspnea |
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Term
| What can occur in severe cases of COPD exacerbation? |
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Definition
| respiratory failure and death |
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Term
| What is the most common etiology of COPD AE? |
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Definition
| 50-60% is respiratory infections (viral and bacterial) |
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Term
| What are other causes of COPD AE? |
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Definition
| 10% d/t environmental pollution and 30% is unknown (MI, heart failure, aspiration, PE) |
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Term
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Definition
| advanced age, productive cough, duration of COPD, abx therapy, hospitalized d/t COPD in past yr, chronic mucus, theophylline therapy, co-morbidity, possible GERD |
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Term
| What meds are used to tx COPD AE? |
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Definition
| abx, inhaled bronchodilators (beta 2 agonist w/ or w/o antocholinergics) PLUS oral glucocorticoids |
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Term
| What are benefits of using non-onvasive mechanical ventilation to tx AE COPD? |
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Definition
| improve respiratory acidosis, increase pH, decreases need for ET intubation, reduces PaCO2, RR, severity of breathlessness, and reduces hospital LOS |
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Term
| What can worsen stable COPD? |
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Definition
| acute bronchitis, pna, PE, CHF |
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Term
| What complications are common in pts w/ advanced COPD? |
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Definition
| Pulmonary HTN, cor pulmonale, chronic respiratory failure |
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Term
| What are other complications of COPD? |
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Definition
| spontaneous pneumothorax and hemoptysis |
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Term
| What are the 2 most important predictors of the disease course? |
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Definition
| Age and severity of airway obstruction |
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Term
| What are other key prognostic factors? |
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Definition
| wt loss, degress of dyspnea, exercise capacity, and hospital admission |
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Term
| When would you need to refer a COPD pt? |
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Definition
| onset b/f 40 yo, > or = 2 AE per yr, severe or rapidly progressive COPD, sx disproportionate to degree of airflow obstruction, need for long-term O2, co-morbidities |
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Term
| What can be done to prevent COPD exacerbations? |
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Definition
| smoking cessation, vaccinations (pneumococcal and influenza) |
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